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1. Health Care for Women: How the U.S. Compares Internationally

Author:
Munira Z. Gunja, Relebohile Masitha, and Laurie Zephyrin
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Recently released federal data once again show the United States with by far the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic.1 Racial disparities are also extreme: Black women in the U.S. are nearly three times more likely to die from pregnancy-related complications than white women are. But maternal deaths and complications may be an indicator of the nation’s wider failures with respect to women’s health and health care. Compared to women in other high-income countries, American women have long had worse access to the health care they need. While the U.S. spends more on health care than other countries do, surveys regularly find that Americans avoid seeking care because of costs at the highest rates, even as the U.S. continues to lead in the prevalence of chronic disease.2 At the same time, limited access to primary care and inadequate coordination of health services are likely factors in the nation’s poor performance when it comes to the prevention, diagnosis, and management of diseases.3 In this brief, we compare selected measures of health care access and outcomes for women in high-income countries. We drew upon data from four sources: the Commonwealth Fund’s 2023 International Health Policy Survey of Australia, Canada, France, Germany, the Netherlands, New Zealand, Switzerland, the United Kingdom, and the United States, which allowed us to analyze responses by race and ethnicity;4 the Centers for Disease Control and Prevention National Vital Statistics System; the Organisation for Economic Co-operation and Development (OECD); and the Institute for Health Metrics and Evaluation Global Burden of Disease. The latter two data sets permitted us to show results on selected measures for five additional countries — Chile, Japan, Korea, Norway, and Sweden. (See “How We Conducted This Survey” for more details.)
Topic:
Women, Public Health, Healthcare System, and Life Expectancy
Political Geography:
United Kingdom, Canada, France, Germany, Australia, and United States of America

2. Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

Author:
David Blumenthal, Evan D. Gumas, Arnav Shah, Munira Z. Gunja, and Reginald D. Williams II
Publication Date:
09-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement. Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower. Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.
Topic:
Development, Public Health, Efficiency, and Healthcare System
Political Geography:
North America and United States of America

3. Insights into the U.S. Maternal Mortality Crisis: An International Comparison

Author:
Munira Z. Gunja, Evan D. Gumas, Relebohile Masitha, and Laurie Zephyrin
Publication Date:
06-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
The United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80 percent — are likely preventable.1 With policies and systems in place to support women during the perinatal period, several high-income countries report virtually no maternal deaths. As policymakers and health care delivery system leaders in the U.S. seek ways to end the nation’s maternal mortality crisis, these countries may offer viable solutions. This brief updates an earlier Commonwealth Fund study of differences in maternal mortality, maternal care workforce composition, and access to postpartum care and social protections between the U.S. and other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.2 In this edition, we have also included data on Chile, Japan, and Korea — all high-income countries with universal health care systems. For our analysis, we used the most recently available data from the U.S. Centers for Disease Control and Prevention (CDC) and from the Organisation for Economic Co-operation and Development (OECD), of which the U.S. is a member. Where country-specific data are more than five years old, we note whether more recent published data from other sources are available for that country. Readers should be aware that because the methods we used to derive updated numbers from other sources may be different from methods the OECD uses, data points may not be comparable to the U.S. rates. For complete details on our methods, see “How We Conducted This Study.”
Topic:
Development, Inequality, Public Health, and Maternal Mortality
Political Geography:
United Kingdom, Canada, Norway, France, Germany, Australia, Switzerland, North America, Sweden, Netherlands, New Zealand, and United States of America

4. Hospital Global Budgeting: Lessons from Maryland and Selected Nations

Author:
Bob Atlas
Publication Date:
06-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Issue: Maryland has utilized hospital global budgeting for a decade, but the approach is rarely used elsewhere in this country. The Centers for Medicare and Medicaid Services now hopes to test global budgeting in more states to help scale up this form of cost containment. Goals: Examine the ways Maryland, Canada, the Netherlands, New Zealand, and Norway employ hospital global budgeting and the lessons they offer to those hoping to see wider adoption in the United States. Methods: Analysis of the various health systems and expert interviews. Key Findings and Conclusion: Maryland and the four selected countries vary significantly in their approaches to hospital global budgeting. With its previous experience using price controls and current global budgeting approach, Maryland has succeeded in holding hospital spending growth steady for nearly a decade. While Norway combines fixed and variable payments to support global budgeting, the Netherlands and Canada’s province of Ontario are moving away from global budgeting in favor of other approaches. Meanwhile, New Zealand has added multiyear rolling forecasts and budgets to support its own model. Future approaches in the U.S. could prove more effective by factoring in the complexities, conflicting incentives, and potential unintended consequences of global budgeting.
Topic:
Public Health, Healthcare System, and Budgeting
Political Geography:
Canada, Maryland, Netherlands, New Zealand, and United States of America

5. Overworked and Undervalued: Unmasking Primary Care Physicians’ Dissatisfaction in 10 High-Income Countries

Author:
Evan D. Gumas, Munira Z. Gunja, Arnav Shah, and Reginald D. Williams II
Publication Date:
08-2023
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
In many countries, including the United States, primary care physicians are reaching a breaking point.1 In 2021, an estimated 117,000 physicians in the U.S. left the workforce for reasons like retirement, burnout, and pandemic-related stressors.2 During the COVID-19 pandemic, primary care physicians around the world saw a dramatic fall in in-person visits in favor of telehealth, accompanied in some countries by decreases in revenue.3 The Commonwealth Fund also found that most primary care physicians experienced increases in their workload because of more time spent processing insurance payments, getting patients medications or treatments because of coverage restrictions, and reporting clinical or quality of care data to external entities. This has contributed to increased stress, emotional distress, demoralization, and burnout.4 This brief explores primary care physician work satisfaction in the first year of the pandemic — 2020 to 2021 — drawing from the 2022 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. (See “How We Conducted This Survey” for more details.) Understanding how primary care physicians feel about their everyday work is crucial to improving their patients’ quality of care and to reversing the steady stream of professionals exiting the primary health care workforce. Across 10 high-income countries, including the U.S., we compare primary care physicians’ time spent with patients, number of patients seen, and job satisfaction.
Topic:
Health Care Policy, Public Health, Primary Care, and Dissatisfaction
Political Geography:
North America, Global Focus, and United States of America

6. Do Americans Face Greater Mental Health and Economic Consequences from COVID-19? Comparing the U.S. with Other High-Income Countries

Author:
Michelle M. Doty, Eric C. Schneider, Roosa Tikkanen, Arnav Shah, and Reginald D. Williams II
Publication Date:
08-2020
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
With more than 4 million confirmed cases and 150,000 deaths as of August, the United States is failing to control the COVID-19 pandemic. At a time when many nations are reopening their economies and societies, the U.S. is struggling in its attempts to do the same. To examine the early impact of the pandemic on the well-being of adults in the U.S. and abroad, the Commonwealth Fund joined the survey research firm SSRS to interview 8,259 adults age 18 and older between March and May 2020. It is the latest in the Commonwealth Fund’s series of cross-national comparisons featuring the United States and nine other high-income countries that participate in the Fund’s annual International Health Policy Survey. The following exhibits illustrate COVID-19’s effects on people’s mental health and economic security and compare levels of public trust in national leaders in responding to the pandemic.
Topic:
Health, Health Care Policy, Mental Health, and Public Health
Political Geography:
United States, Europe, and Global Focus